Which payers have published criteria for MR spectroscopy (CPT 76390)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for MR spectroscopy (CPT 76390)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting MR spectroscopy (CPT 76390)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does MR spectroscopy (CPT 76390) cost?

Across 607 hospitals that publish their negotiated rates, the median commercial insurance rate is $578, with the middle half of rates between $236 and $1,281. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if MR spectroscopy (CPT 76390) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 76390: MR spectroscopy - Prior Authorization and Price

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CPT 76390

Conducting an MRI to assess biochemical changes occurring in the brain.

MRI Other

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	19 that name this code
Anthem BCBS	Carelon	Oncologic imaging effective Apr 4, 2026	3 that name this code
Cigna	eviCore	Pediatric and Special Populations Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Oncology Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Head Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Abdomen Imaging Guidelines 1.0.2026, effective Feb 3, 2026	19 that name this code
Medicare	CMS	NCD 220.2: Magnetic Resonance Imaging effective Apr 10, 2018	1 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	19 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss MR spectroscopy. Each has its own criteria for when the study is considered appropriate.

Primary Central Nervous System Tumors Aetna · Cigna · UnitedHealthcare
Metastatic Cancer, Carcinoma of Unknown Primary Site, and Other Types of Cancer Aetna · Cigna · UnitedHealthcare
Prostate Cancer Aetna · Cigna · UnitedHealthcare
CNS Tumors Aetna · Cigna · UnitedHealthcare
Developmental Disorders Aetna · Cigna · UnitedHealthcare
Epilepsy and Other Seizure Disorders Aetna · Cigna · UnitedHealthcare
Imaging Techniques Aetna · Cigna · UnitedHealthcare
Liver Lesion Characterization Aetna · Cigna · UnitedHealthcare
Other Imaging Studies Aetna · Cigna · UnitedHealthcare
Pediatric Demyelinating Diseases Aetna · Cigna · UnitedHealthcare
Specialized Imaging Techniques Aetna · Cigna · UnitedHealthcare
Cancer screening, not otherwise specified Anthem BCBS
Histiocytic Neoplasms Anthem BCBS
Magnetic Resonance Imaging Medicare
Neuroendocrine Tumors Anthem BCBS

Typical price

Commercial insurance, median

$578

Middle half of rates: $236 to $1,281

Medicare, hospital outpatient

$89

Facility payment

Commercial figures come from negotiated rates published by 607 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for MR spectroscopy change.

CPT 76390: MR spectroscopy - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

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CPT 76390: MR spectroscopy - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET